Sleep Disturbances Heighten Risk of COVID-19 Infection
Sleep Disturbances and Increased COVID-19 Vulnerability: New Insights from a Meta-Analysis
Individuals with preexisting sleep disturbances, such as obstructive sleep apnea (OSA), insomnia, and abnormal sleep duration, show a significantly higher susceptibility to COVID-19, as well as increased risks of hospitalization, mortality, and long COVID, according to a new analysis of data from over 8 million people.
Despite being common in the general population, sleep disturbances are often overlooked as a COVID-19 risk factor, wrote Dr. Jiawei Zhou and colleagues from The First Hospital of China Medical University, Shenyang, China. Previous research has predominantly focused on how COVID-19 affects sleep rather than how sleep disturbances influence COVID-19 outcomes, with most studies concentrating only on OSA.
In a meta-analysis published in eClinicalMedicine, part of The Lancet Discovery Science, the researchers reviewed 48 observational studies published between October 27, 2023, and May 8, 2024, involving 8,664,026 adults. These studies examined the relationship between COVID-19 and various sleep disturbances, including OSA, insomnia, abnormal sleep duration, and night shift work.
The primary outcomes assessed were COVID-19 susceptibility, hospitalization, mortality, and long COVID. The presence of preexisting sleep disturbances was linked to a significantly increased risk for each of these outcomes, with odds ratios (ORs) of 1.12 for susceptibility, 1.25 for hospitalization, 1.45 for mortality, and 1.36 for long COVID.
Subgroup analyses revealed that the association between preexisting sleep disturbances and increased susceptibility and hospitalization was stronger in younger adults (under 60 years) than in older adults (60 years and older). However, the risk of death was higher in older adults with sleep disturbances (OR 2.07) compared to younger adults (OR 1.22). Men with sleep disturbances faced a higher risk of COVID-19 mortality than women.
Preexisting sleep disturbances were significantly associated with long COVID, especially when long COVID was defined as symptoms lasting three or more months compared to those lasting one month (P = .029).
The analysis also found specific sleep disturbances had distinct impacts on COVID-19 outcomes. OSA was linked to all four primary outcomes, while abnormal sleep duration was associated with increased risk for COVID-19 susceptibility, hospitalization, and long COVID. Night shift work was associated with higher susceptibility and hospitalization risk, and insomnia was linked to long COVID.
The exact mechanisms behind these associations remain uncertain, but the researchers suggest that persistent sleep deprivation may contribute to elevated levels of C-reactive protein and interleukin-6, promoting a compromised immune response and a persistent inflammatory state.
"Overall, compromised innate and adaptive immune functions combined with persistent inflammation may explain the higher risk of susceptibility, severity, and longer recovery time in patients with sleep disturbances. Early intervention for sleep disturbances could mitigate the adverse effects of COVID-19," the researchers noted.
However, the findings have limitations, including the observational nature of the studies and the heterogeneity of outcomes. The researchers call for randomized, controlled trials to further examine the effects of interventions for sleep disturbances on COVID-19 prevention and progression.
This study is the first to examine multiple types of sleep disturbances and their potential impacts on the full clinical course of COVID-19, highlighting the need for early evaluation and intervention for those with sleep disturbances to reduce both short-term and long-term effects of the disease.
Addressing Sleep Issues Early
While the results of this study are not unexpected, "meta-analyses are valuable to identify potential signals in published data that suggest the need for new studies," said Dr. Arun Chatterjee, professor of pulmonary, critical care, allergy, and immunologic diseases at Wake Forest University, who was not involved in the meta-analysis.
"Lack of sleep, whether acute or chronic, affects immune function by reducing lymphocyte proliferation, lowering immune globulin levels, increasing inflammatory markers, shortening telomeres, and generally impairing the immune system," Chatterjee explained.
The main takeaway is that adequate sleep is crucial for overall health, Chatterjee emphasized. "Sleep disruption affects health across various systems. Incorporating annual sleep wellness and screening into healthcare visits could be beneficial," he suggested.
More research is needed to fully understand the impact of sleep disruption on immune status and other physiological and mental health systems, Chatterjee concluded.
The study was supported by the National Natural Science Foundation of China and the Key Laboratory of Respiratory Diseases of Liaoning Province. The researchers and Dr. Chatterjee disclosed no financial conflicts of interest.
